|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$99,972.03
|
|
|
Service Code
|
MSDRG 352
|
| Min. Negotiated Rate |
$7,611.00 |
| Max. Negotiated Rate |
$99,972.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35,403.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$99,972.03
|
| Rate for Payer: EPIC Health Plan Senior |
$66,648.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$60,589.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84,824.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81,189.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,844.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,823.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,611.00
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$34,886.77
|
|
|
Service Code
|
APR-DRG 2283
|
| Min. Negotiated Rate |
$27,863.52 |
| Max. Negotiated Rate |
$34,886.77 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,863.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34,886.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31,214.48
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$79,855.08
|
|
|
Service Code
|
APR-DRG 2284
|
| Min. Negotiated Rate |
$63,778.99 |
| Max. Negotiated Rate |
$79,855.08 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63,778.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79,855.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71,449.28
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$19,890.62
|
|
|
Service Code
|
APR-DRG 2281
|
| Min. Negotiated Rate |
$15,886.33 |
| Max. Negotiated Rate |
$19,890.62 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15,886.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19,890.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,796.88
|
|
|
INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES
|
Facility
|
IP
|
$25,356.13
|
|
|
Service Code
|
APR-DRG 2282
|
| Min. Negotiated Rate |
$20,251.54 |
| Max. Negotiated Rate |
$25,356.13 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20,251.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25,356.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,687.06
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC INITIAL DAY
|
Facility
|
IP
|
$1,697.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
909020046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$339.40 |
| Max. Negotiated Rate |
$1,442.45 |
| Rate for Payer: Adventist Health Commercial |
$339.40
|
| Rate for Payer: Cash Price |
$763.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,187.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.80
|
| Rate for Payer: EPIC Health Plan Senior |
$678.80
|
| Rate for Payer: Galaxy Health WC |
$1,442.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,018.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,077.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,001.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.28
|
| Rate for Payer: Multiplan Commercial |
$1,357.60
|
| Rate for Payer: Networks By Design Commercial |
$1,103.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,442.45
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC INITIAL DAY
|
Facility
|
OP
|
$1,697.00
|
|
|
Service Code
|
CPT 32561
|
| Hospital Charge Code |
909020046
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.85 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$339.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$763.65
|
| Rate for Payer: Cash Price |
$763.65
|
| Rate for Payer: Cash Price |
$763.65
|
| Rate for Payer: Cigna of CA HMO |
$1,086.08
|
| Rate for Payer: Cigna of CA PPO |
$1,255.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,187.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$1,442.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,018.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,077.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$1,357.60
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,103.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,442.45
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,018.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC SUB DAY
|
Facility
|
OP
|
$1,787.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
909020047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$23.77 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$357.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$804.15
|
| Rate for Payer: Cash Price |
$804.15
|
| Rate for Payer: Cash Price |
$804.15
|
| Rate for Payer: Cigna of CA HMO |
$1,143.68
|
| Rate for Payer: Cigna of CA PPO |
$1,322.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,250.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$1,518.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,072.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,134.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$1,429.60
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,161.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,518.95
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,072.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$893.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
INJ CHEST TUBE W/FIBRINOLYTIC SUB DAY
|
Facility
|
IP
|
$1,787.00
|
|
|
Service Code
|
CPT 32562
|
| Hospital Charge Code |
909020047
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$357.40 |
| Max. Negotiated Rate |
$1,518.95 |
| Rate for Payer: Adventist Health Commercial |
$357.40
|
| Rate for Payer: Cash Price |
$804.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,250.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.80
|
| Rate for Payer: EPIC Health Plan Senior |
$714.80
|
| Rate for Payer: Galaxy Health WC |
$1,518.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,072.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,134.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,054.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.88
|
| Rate for Payer: Multiplan Commercial |
$1,429.60
|
| Rate for Payer: Networks By Design Commercial |
$1,161.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,518.95
|
|
|
INJECTION, ACETAMINOPHEN (HIKMA), NOT THERAPEUTICALLY EQUIVALENT TO J0131, 10 MG
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT J0137
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.10
|
|
|
INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 24220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$343.38 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$343.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$388.34
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; BRACHIAL PLEXUS, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 64415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$121.35 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$121.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 64447
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$82.56 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,216.56
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 64445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.98 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,143.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,216.56
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, LUMBAR OR SACRAL (CAUDAL); WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 62322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$232.68 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$232.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$263.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,592.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN [219527]
|
Facility
|
OP
|
$29,858.59
|
|
|
Service Code
|
HCPCS J9229
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,873.10 |
| Max. Negotiated Rate |
$25,379.80 |
| Rate for Payer: Adventist Health Commercial |
$5,971.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,235.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,309.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,160.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,873.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,308.38
|
| Rate for Payer: Blue Shield of California Commercial |
$3,009.20
|
| Rate for Payer: Cash Price |
$13,436.37
|
| Rate for Payer: Cash Price |
$13,436.37
|
| Rate for Payer: Cigna of CA HMO |
$20,901.01
|
| Rate for Payer: Cigna of CA PPO |
$20,901.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,591.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,160.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,160.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,901.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,740.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,160.41
|
| Rate for Payer: Galaxy Health WC |
$25,379.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,915.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,711.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,873.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,873.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,960.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,351.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,022.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,166.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,620.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,849.95
|
| Rate for Payer: Multiplan Commercial |
$23,886.87
|
| Rate for Payer: Networks By Design Commercial |
$14,929.30
|
| Rate for Payer: Prime Health Services Commercial |
$25,379.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,915.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17,915.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,205.93
|
| Rate for Payer: United Healthcare All Other HMO |
$10,907.34
|
| Rate for Payer: United Healthcare HMO Rider |
$10,671.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,778.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,873.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,591.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,160.41
|
| Rate for Payer: Vantage Medical Group Senior |
$3,160.41
|
|
|
INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN [219527]
|
Facility
|
IP
|
$29,858.59
|
|
|
Service Code
|
HCPCS J9229
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,971.72 |
| Max. Negotiated Rate |
$25,379.80 |
| Rate for Payer: Adventist Health Commercial |
$5,971.72
|
| Rate for Payer: Blue Shield of California Commercial |
$15,138.31
|
| Rate for Payer: Blue Shield of California Commercial |
$22,961.26
|
| Rate for Payer: Cash Price |
$13,436.37
|
| Rate for Payer: Cigna of CA HMO |
$20,901.01
|
| Rate for Payer: Cigna of CA PPO |
$20,901.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,901.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,943.44
|
| Rate for Payer: EPIC Health Plan Senior |
$11,943.44
|
| Rate for Payer: Galaxy Health WC |
$25,379.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,915.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,960.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17,616.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,166.06
|
| Rate for Payer: Multiplan Commercial |
$23,886.87
|
| Rate for Payer: Networks By Design Commercial |
$14,929.30
|
| Rate for Payer: Prime Health Services Commercial |
$25,379.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,205.93
|
| Rate for Payer: United Healthcare All Other HMO |
$10,907.34
|
| Rate for Payer: United Healthcare HMO Rider |
$10,671.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,778.69
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; YOUNGER THAN 5 YEARS OF AGE
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 36560
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$440.95 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,262.29
|
| Rate for Payer: Blue Shield of California Commercial |
$4,136.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$440.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$498.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
INSERTION OF WIRE OR PIN WITH APPLICATION OF SKELETAL TRACTION, INCLUDING REMOVAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$32,312.00
|
|
|
Service Code
|
CPT 20650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.12 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,891.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$47,354.12
|
|
|
Service Code
|
APR-DRG 1762
|
| Min. Negotiated Rate |
$37,820.99 |
| Max. Negotiated Rate |
$47,354.12 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37,820.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47,354.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42,369.47
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$33,244.41
|
|
|
Service Code
|
APR-DRG 1761
|
| Min. Negotiated Rate |
$26,551.79 |
| Max. Negotiated Rate |
$33,244.41 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26,551.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,244.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,745.00
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$62,187.11
|
|
|
Service Code
|
APR-DRG 1763
|
| Min. Negotiated Rate |
$49,667.87 |
| Max. Negotiated Rate |
$62,187.11 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$49,667.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62,187.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55,641.10
|
|
|
INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES
|
Facility
|
IP
|
$112,822.84
|
|
|
Service Code
|
APR-DRG 1764
|
| Min. Negotiated Rate |
$90,109.82 |
| Max. Negotiated Rate |
$112,822.84 |
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90,109.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112,822.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100,946.75
|
|
|
INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]
|
Facility
|
IP
|
$11.32
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: Cigna of CA PPO |
$7.92
|
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8.71
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cigna of CA HMO |
$7.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.53
|
| Rate for Payer: EPIC Health Plan Senior |
$4.53
|
| Rate for Payer: Galaxy Health WC |
$9.62
|
| Rate for Payer: Global Benefits Group Commercial |
$6.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$9.06
|
| Rate for Payer: Networks By Design Commercial |
$5.66
|
| Rate for Payer: Prime Health Services Commercial |
$9.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Other HMO |
$4.14
|
| Rate for Payer: United Healthcare HMO Rider |
$4.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.71
|
|
|
INSULIN DEGLUDEC (U-100) 100 UNIT/ML SUBCUTANEOUS SOLUTION [223708]
|
Facility
|
OP
|
$11.32
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
901700025
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: Adventist Health Commercial |
$2.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.27
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cigna of CA HMO |
$7.92
|
| Rate for Payer: Cigna of CA PPO |
$7.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.53
|
| Rate for Payer: EPIC Health Plan Senior |
$4.53
|
| Rate for Payer: Galaxy Health WC |
$9.62
|
| Rate for Payer: Global Benefits Group Commercial |
$6.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.92
|
| Rate for Payer: Multiplan Commercial |
$9.06
|
| Rate for Payer: Networks By Design Commercial |
$5.66
|
| Rate for Payer: Prime Health Services Commercial |
$9.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Other HMO |
$4.14
|
| Rate for Payer: United Healthcare HMO Rider |
$4.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.62
|
| Rate for Payer: Vantage Medical Group Senior |
$9.62
|
|
